3.1.15 Nursing Homes

There are three types of licensed facilities in North Dakota that provide housing for senior citizens and physically disabled individuals. These facilities provide resident care that ranges from apartment-like living (assisted living facilities) to individual sleeping quarters with congregate meals (basic care facilities) to complete care for residents with long-term medical needs (nursing homes). Each of these various types of facilities operates under licenses issued by the North Dakota Department of Human Services.

The following table identifies how many of each of these facilities there are in North Dakota and the capacity of each type facility.

Senior Citizen & Physically Disabled Housing

Nursing homes are required to provide non-emergency medical transportation services for their residents. There are no other transportation-related requirements for licensed senior housing facilities. Assuming an occupancy rate of 85 percent, it is estimated that approximately 8,000 North Dakotans live in these licensed facilities. This total represents about 8.6 percent of the state's population that is 65 an older.

In an attempt to quantify transportation services that are provided to the residents of these various types of assisted living facilities, licensees were surveyed to determine what transportation services are provided to residents. The map in Figure 3.5 shows the communities in North Dakota that have one or more long term care facilities.

3.1.16 Developmental Disabilities Service Providers

The North Dakota Department of Human Services (DHS) licenses entities to provide residential services to developmentally disabled individuals in North Dakota. As of August, 2004, there were 34 such entities in the state operating a total of 101 residential group homes in the state. Many of these group homes provide transportation services for their residents.

Approximately 775 developmentally disabled individuals reside in licensed group homes in North Dakota. DHS estimates that licensees provide residential services for an additional 1,000 developmentally disabled individuals who live outside group homes.

Group home operators receive Medicaid reimbursement through DHS for services provided. Each licensee purchases its own vehicles and amortizes related expenses and vehicle operating costs into its operating budget. The exact amount that is paid for transportation services is unknown since related costs are built into each licensee's overall cost of doing business. These costs are subject, however, to review and approval by DHS.⁴⁶

All of North Dakota's developmental disabilities service providers were surveyed as a part of this study. Survey questions focused on the types of transportation services that are being provided, the number of clients served, and the number of trips provided.

Twenty-eight of North Dakota's 34 licensees responded to this survey. These respondents operate 74 of the state's 101 group homes and provide 3,995 clients with residential and other services. Most group homes have at least one vehicle at the home for resident/client use; these vehicles are capable of satisfying the majority of their needs. Group homes do not keep a record of trip purposes. Many indicated, however, that employment and medical trips are the most frequented trips. Respondents indicated that they operate a total of 156 vehicles to provide transportation services to their clients.

3.2 Regional Services Inventories & Coordination Efforts

The previous section of this chapter described major transportation programs administered by state agencies - primarily the North Dakota Department of Transportation and the North Dakota Department of Human Services. The remainder of this section will discuss public transportation services that are available in each of the state's eight planning regions.

While many of the services discussed in the following pages are governed by the programs discussed earlier, these discussions will more fully describe the services being provided and efforts that are taking place to coordinate them with other local service providers. These services are evaluated and discussed at the regional level. There are eight established economic planning regions in North Dakota (Figure 3.6). SURTC facilitated transportation coordination focus group meetings in each of the state's regions.

The following subsections will include a description of each region's geographic size, demographics, major community, and transportation funding and expenditures. Information will also be presented concerning transportation service vehicles that are in place within each region and ongoing local coordination efforts.

3.2.1 Region 1 - Williston

Region 1 consists of Divide, McKenzie, and Williams Counties (Figure 3.7). With a total surface area of 6,303 square miles, it is the smallest region in North Dakota. The region has a total estimated population of 27,781; 4.4 residents per square mile. Williston, with an estimated 2003 population of 12,114, is the largest community in region. Williston serves as the region's shopping and medical center and the location for the regional meeting, the minutes of the Region 1 Focus Group meeting are presented in Appendix G.

As Figure 3.8 illustrates, a high percentage of the region's population is potentially transportation disadvantaged. The potentially disadvantaged include three groups of residents: 7,978 disabled residents or 28.7 percent of the population, 4,835 senior residents or 17.4 percent of the population, 4,414 low-income residents or 15.9 percent of the population. There may be some overlap as these are not three separate and distinct groups.

The Williston Council on Aging (WCA) is the primary pubic transportation service provider in the region. WCA provides paratransit serves in Williston. Paratransit service is also provided for Watford City, Crosby, and rural areas near Williston. Souris Basin Transportation provides weekly service from Crosby to Minot. Local taxi service is also available in Williston. There are no commercial intercity bus services in the region but Amtrak does provide daily eastbound and westbound passenger service out of Williston.

Other client-specific transportation services are provided by the region's nursing homes, basic care centers, assisted living facilities, and facilities for residents with developmental disabilities. As indicated in Table 3.1, nine entities responded to a survey concerning the provision of local transportation services. These nine entities operate 15 vehicles which provide transportation services to the general public or to specific client groups in Region 1.

Table 3.1 Number of Vehicles by Agency in Region 1

* NH = nursing home, BC = basic care, AL = assisted living, DD = developmental disabilities, and T = transit.
NR = No response to survey

Region 1 ranks last in the state in terms of total and per capita dollars available to support public transportation services. As Table 3.2 indicates, the region spends only $171,587 or $6.18 per capita annually on local public transportation services.

Table 3.2 Region 1 Transportation Dollars

The region's transit dollars come from a variety of sources. As Table 3.2 illustrates, primary funding sources include FTA Section 5311, state aid, and Title III B of the Older American Act (OAO): this region has no local tax or mill levy from counties or cities to support transit. "Other" sources of funding include fund-raising projects and donations.

Medicaid revenues listed in Table 3.2 are monies that Medicaid provided directly to eligible clients in the region in 2003 to reimburse them for transportation-related expenditures. Related transportation services were provided by local taxi and transit operators.

As discussed in early portions of this section, there are other government programs that provide funding to give eligible program clients access to related services. This money flows into the region to reimburse area residents for transportation costs incurred to access various federal programs, including repair and insurance coverage for personal vehicles. These reimbursements for vehicle repair and other transportation costs for Region 1 amount to:

• Vocational Rehabilitation (DHS) - $10,371
• TANF and JOBS (DHS) - $58,869
• Workforce Investment Act (JSND) - $361

Little or no coordination is taking place between DOT and DHS programs in Region 1. Williston's public school district is looking for an affordable means of transporting students living in Williston. Insuring the viability of Williston's taxi service is a local concern.